Aura Jurescu

Background/Objectives: The COVID-19 pandemic disrupted healthcare systems worldwide, raising concerns about delayed cancer diagnosis and treatment. This study evaluated whether renal cell carcinoma (RCC) diagnosed after the pandemic showed more advanced pathological features at presentation. Methods: This retrospective study included all partial and radical nephrectomy specimens with a histopathological diagnosis of RCC examined between March 2018 and February 2023, stratified into pre-COVID (2018–2020), COVID (2020–2021), and post-COVID (2021–2023) periods. Pathological variables were compared using Pearson’s χ² and Kruskal–Wallis tests; odds ratios with 95% confidence intervals were calculated with Holm-Bonferroni correction, and multivariable logistic regression, adjusting for age, sex, tumor size, residence, and histological subtype, was performed for high pathological stage and vascular invasion. Results: A total of 297 RCC cases were included (121 pre-COVID, 46 COVID, 130 post-COVID). Post-COVID tumors more frequently showed advanced pathological stage (61.5% vs. 41.3% and 34.8%; p < 0.001) and vascular invasion (56.9% vs. 29.8% and 34.8%; p < 0.001) than pre-COVID and COVID tumors. These associations survived Holm-Bonferroni correction, except for the post-COVID vs. COVID vascular invasion comparison. Both associations remained significant, and numerically stronger, after multivariable adjustment (adjusted OR 2.91, 95% CI 1.61–5.25 for stage; adjusted OR 3.80, 95% CI 2.11–6.83 for vascular invasion). WHO/ISUP grade, tumor necrosis, and sarcomatoid/rhabdoid differentiation did not differ significantly among periods. Conclusions: This study demonstrates a temporal association between the post-pandemic period and more advanced RCC at surgery, independent of age, sex, tumor size, residence, and histological subtype. These findings are consistent with, though do not establish, pandemic-related delays in diagnosis and treatment as a contributing factor, underscoring the need for studies incorporating institutional healthcare-utilization and outcome data.

Pleomorphic adenomas (PAs) are benign mixed tumors of the salivary glands that usually present with morphological characteristics consisting of epithelial and myoepithelial cells and a chondromyxoid stromal component. Atypical cells; squamous, osseous, lipomatous, endocrine-like or apocrine metaplasia; aspects of invasion (vascular, perineural, in adjacent tissues or the capsule); necrosis; and unusual dimensions were reported as uncommon aspects that can be encountered in PAs. This study consisted of a retrospective analysis of the morphological characteristics of PAs, aiming to identify their unusual features and prevent misdiagnosis. We discuss the diverse morphological aspects of PAs, with particular emphasis on the challenges associated with their diagnosis.

Aim: This study aimed to identify the clinical and pathological features of primary cutaneous melanomas in young patients, comparing them with those of older patients. Materials and Methods: We performed a retrospective study observing the differences with respect to clinical and pathological features in young patients versus older patients. We distributed the cases into two groups: patients < 40 years diagnosed with cutaneous melanoma and patients ≥ 40 years diagnosed with cutaneous melanoma. Results: From the total number of primary cutaneous melanomas diagnosed, 11% of cases were represented by young patients. The clinical and pathological features more frequently associated with cutaneous melanomas in AYAs (adolescents and young adults) were represented by the superficial spreading subtype (p = 0.0003), a brisk inflammatory infiltrate (p = 0.0061), a pT1–pT2 pathological stage (p = 0.0183), decreased mitotic activity (p = 0.0186), decreased Breslow index (p = 0.0301), and female sex (p = 0.022). Conclusions: The most important features of cutaneous melanomas diagnosed in AYA patients were represented by the superficial spreading subtype, the presence of a brisk inflammatory infiltrate, and a pT1–pT2 pathological stage.

Background and Objectives: This study aimed to identify the risk factors of primary cutaneous melanomas associated with microsatellites, satellites, and in-transit metastases. Materials and Methods: We performed a retrospective study on patients diagnosed with invasive primary cutaneous melanomas in two pathology departments. The cases were distributed into two groups, comparing the clinical–pathological features of cases that presented microsatellites, satellites, and in-transit metastases with cases that did not present microsatellites, satellites, and in-transit metastases. Results: From the total number of primary invasive cutaneous melanomas diagnosed (n = 204), 22% presented microsatellites, satellites, and in-transit metastases (n = 46). The presence of microsatellites, satellites, and in-transit metastases was strongly correlated with a Breslow index > 4 mm, a Clark level of IV or V, and a pT3 or pT4 pathological stage (p < 0.0001). Those cases were also associated with lymphovascular invasion (p = 0.0013), ulceration of the primary melanoma (p = 0.0037), and an increased mitotic rate (p = 0.0078). The presence of microsatellites, satellites, and in-transit metastases is associated with higher rates of lymph node metastases (p = 0.0006) and recurrence (p = 0.0282). Conclusions: The most important risk factors associated with microsatellites, satellites, and in-transit metastases are represented by a Breslow index > 4 mm, a Clark level of IV or V, and an advanced pathological stage.

Background and Objectives: Renal cell carcinoma (RCC) exhibits heterogeneous and sometimes unpredictable metastatic behavior, involving both common and uncommon anatomic sites. Institutional analyses of histopathologically confirmed metastatic RCC may improve diagnostic recognition and clinical awareness. This study aimed to characterize the metastatic distribution and histopathologic features of RCC diagnosed in a single tertiary center over a five-year period. Materials and Methods: A retrospective review of the pathology database of the Department of Pathology, “Pius Brînzeu” Emergency County Hospital, Timișoara, was performed to identify all histologically confirmed cases of metastatic RCC diagnosed between January 2020 and December 2024. Case identification was based on pathology reports of metastatic lesions. In a subset of cases, corresponding pathology reports of the primary renal tumor were available and reviewed. Histopathological data collected included WHO/ISUP grade, tumor necrosis, sarcomatoid and/or rhabdoid differentiation, vascular invasion, surgical margin status, tumor size, and pathological T stage (pT). Exploratory analyses were performed to assess associations between metastatic site and selected histopathological features. Results: Thirty-two cases of metastatic RCC were identified, all demonstrating clear cell morphology. The mean patient age was 62.9 years, with a marked male predominance. Among cases with available primary tumor data, high WHO/ISUP grade and adverse histopathologic features were frequently observed. The most common metastatic sites in our institution were the brain and bone, followed by the adrenal gland, lymph nodes, and liver. Less frequent metastatic involvement included the pancreas, testis, vagina, skin, and peritoneum. Exploratory analyses did not demonstrate statistically significant associations between metastatic site and tumor grade, necrosis, or sarcomatoid/rhabdoid differentiation; however, descriptive trends were observed, including the association of brain metastases with high-grade tumors and the high prevalence of tumor necrosis across metastatic sites. Conclusions: This pathology-based retrospective series highlights the broad metastatic spectrum of RCC, including both typical and rare anatomic sites. The predominance of clear cell morphology and the frequent association with adverse histopathologic features support the link between aggressive tumor biology and metastatic disease. Although no statistically significant associations were identified, the observed patterns suggest potential relationships between metastatic distribution and tumor characteristics, warranting further investigation in larger studies.

Background/Objectives: Traditional histopathological classification of endometrial cancer (EC) exhibits limited prognostic precision due to interobserver variability and incomplete reflection of tumor biology. The Cancer Genome Atlas (TCGA) introduced molecular subtypes, with POLE-ultramutated tumors showing superior outcomes. This systematic review and meta-analysis assesses the prognostic impact of pathogenic/likely pathogenic POLE exonuclease-domain mutations (EDM) on survival in EC. Methods: PRISMA 2020-compliant search of PubMed, Embase, and Web of Science (2015–2025) identified 20 studies (n = 7708 EC patients; 159 POLE-mutant, 2.1%). Eligibility: Adult EC patients with POLE EDM vs. non-POLE, reporting OS/PFS/DFS/RFS/CSS hazard ratios (HR). ROBINS-I assessed bias; random-effects meta-analysis pooled multivariable HR. Results: The meta-analysis revealed a significantly reduced risk of death in POLE-mutant endometrial cancer patients, with an OS pooled hazard ratio (HR) of 0.35 (95% CI 0.21–0.58; I² = 17.9%) across eight studies. Disease control endpoints (DFS/PFS/RFS) from 10 studies showed an even more substantial benefit, with a pooled HR of 0.22 (95% CI 0.12–0.41; I² = 0%). Cancer-specific survival HRs ranged from 0.00 to 0.32 across four studies, often with zero events in POLE cohorts. ROBINS-I bias was low to moderate; heterogeneity stemmed from the comparators and stages. Conclusions: POLE-EDM confers a robust, favorable prognosis across EC stages, supporting molecular risk stratification and treatment de-escalation.

Background and objectives: Colorectal cancer (CRC) presents a variety of molecular and pathological characteristics due to its location in the large intestine, which influences its management and prognosis. We aimed to evaluate the clinicopathological disparities between right colon (RCC), left colon (LCC), and rectal carcinomas. Materials and methods: A retrospective observational study was conducted to examine consecutive cases of colorectal carcinomas diagnosed at the “Pius Brinzeu” County Emergency Clinical Hospital (PBCECEHT), Romania. The clinicopathological characteristics and metastatic spread were analyzed by the site of the malignant tumor (right colon, left colon, or rectum). Results: A total of 1812 patients met the inclusion criteria, predominantly males (57.95%). Patients with RCC had an almost equal distribution between sexes, while patients with LCC and rectal carcinomas were more frequently males (p < 0.0001). RCC tumors were mostly high-grade (p < 0.0001), deeply invasive (p < 0.0001), and mucinous (p = 0.0109), with lymphovascular invasion and distant metastases. Conclusions: We observed different clinicopathological characteristics of CRC depending on the site of origin. We emphasize that tumor location is a parameter worth considering in CRC patients, both in therapeutic management and in future clinical trials.

Lipodystrophy is a rare group of metabolic disorders characterized by the abnormal distribution of body fat, which can lead to various metabolic complications due to the body’s inability to adequately process carbohydrates and fat. We report the case of a female, aged 53 years, who was admitted as an outpatient for progressive weight loss of the upper part of the body (face, neck, arms, and chest), dyspeptic complaints, fatigue, mild insomnia, and anxious behavior. Her medical history was characterized by the presence of dyslipidemia, hypertension, and a minor stroke episode. However, she denied any family-relevant medical history. Although the clinical perspective suggested a possible late onset of partial acquired lipodystrophy, due to the imaging exam that revealed an enlarged liver with inhomogeneous structure with multiple nodular lesions, scattered over both lobes, a lot of lab work-ups and complementary studies were performed. Eventually, a liver biopsy was performed by a laparoscopic approach during cholecystectomy, the histology consistent with metabolic disease-associated steatohepatitis (MASH). In conclusion, given their heterogeneity and rarity, lipodystrophies may be either overlooked or misdiagnosed for other entities. Barraquer–Simons syndrome (BSS) may be associated with liver disease, including cirrhosis and liver failure. Liver lipodystrophy in BSS may sometimes feature steatosis with a focal, multi-nodular aspect, multiplying the diagnostic burden. Liver lipodystrophy may manifest as asymptomatic fat accumulation but may progress to severe conditions, representing one of the major causes of mortality in BSS, apart from the cardio-vascular comorbidities. Given the potential of severe outcomes, it is mandatory to correctly assess the stage of liver disease since the first diagnosis.

Background and Objectives: Multiple primary malignancies involving endometrial carcinoma (EC) present complex diagnostic and management challenges. This study aimed to identify clinical, pathological, and demographic patterns among patients with EC and a second primary tumor and assess the role of comorbidities in tumor behavior. Materials and Methods: We retrospectively analyzed 35 women diagnosed with EC and a second malignancy between 2017 and 2024. We evaluated clinical variables, tumor characteristics, and comorbidities. Statistical analysis included chi-square tests, Mann–Whitney U tests, Kruskal–Wallis tests, Spearman correlations, and logistic regression. Multiple testing correction was applied using the Benjamini–Hochberg method. Results: Endometrioid EC was the most prevalent subtype (80%), most frequently associated with breast (28.5%) and colorectal cancers (11.4%). Obesity (45.7%), hypertension (62.9%), and diabetes (22.9%) were common. While univariate analysis suggested associations between comorbidities and tumor features (e.g., obesity and tumor type, ρ = 0.30, p = 0.08), no correlation remained significant after adjustment. Logistic regression identified age (OR = 0.88, CI: 0.79–0.98, p = 0.022) and obesity (OR = 0.11, CI: 0.01–0.83, p = 0.033) as independent predictors of non-endometrioid histology. Conclusions: These findings suggest that age and obesity may influence histological differentiation in EC with multiple primaries. This study suggest that age and obesity may play a role in the histological differentiation of EC in patients with multiple primary tumors. The small cohort size (n = 35) limits the statistical power and generalizability of the results; therefore, they should be regarded as exploratory and hypothesis-generating, warranting validation in larger prospective studies.